Midwifery Guru To Bring Her Ideas To Madison
By Mary Bergin, The Capital Times
Here are some of the things that Ina May Gaskin, described as the most famous midwife in the world, believes: Labor usually should not be induced. Pregnant women should be given a "due month" instead of a "due date." Surgical interventions during childbirth (Cesarean sections, episiotomies) often are unnecessary. A doctor is more likely to be sued for not doing a C-section than for performing one. Malpractice judgments help dictate which medical practices are acceptable.
The United States doesn't keep accurate statistics about childbirth complications. We ignore the maternal problems that show up because of, but after, birth (like abdominal adhesions or bowel obstructions that develop because of C-sections).
Gaskin, who will be in Madison next week, has witnessed the birth of about 1,100 babies and given birth to five of her own. Her work during the past 30 years has been credited with helping to revive and define midwifery in this country.
Unlike the estimated 140 certified nurse midwives in Wisconsin, she carries no malpractice insurance. "I've never been sued," she says. "Our clients understand our circumstances." But she also acknowledges this issue is "stifling midwifery in some places, because state laws may require proof of malpractice insurance." In Wisconsin, midwife Aszani Kunkler says the insurance is required, as are state licensing and the development of practice guidelines that are approved by a physician who has training in obstetrics.
Gaskin's dogged persistence has helped strengthen the midwifery movement in this country. So have her experiences at The Farm, a renowned Tennessee commune founded by her and husband Stephen Gaskin in 1971, their hippie era. By the late 1970s, it was dubbed the largest working commune in America. The Gaskins still live there. The Farm Midwifery Center that Ina May Gaskin developed "was a point of strength for us. We learned quickly that natural childbirth worked."
A part of the learning process was accidental. At The Farm's peak, it had about 1,250 permanent residents, and the group was lean financially. That meant healthy living: drinking water and eating vegetables they grew because they couldn't afford pop or junk food. "And we walked everywhere, so we were fit," Gaskin says. "During these formative years, it was a pure culture."
Another route for growth at this "family monastery" was deliberate. Abortion was prohibited. Sex, marriage and childbirth were considered sacred. Gaskin and other Farm women helped each other prepare for, appreciate and celebrate the process of labor - instead of dread the physical pain of it.
Here is another one of the midwife's beliefs: Pregnant women will make decisions about childbirth that are based on the experiences of their friends.
She talks about the critical points of decision-making during labor. Childbirth that is pre-scheduled surgery, for the convenience of the mother, often is ill-conceived, Gaskin says, and labor often is erroneously categorized as "complicated" if contractions end. "It is normal for labor to progress, stop or go backwards (for the cervix to close)," she explains. "This is within the normal capacity of women, as it is with all mammals."
A part of the challenge, Gaskin says, is helping women believe that their bodies are capable of delivering a baby without drugs or surgery. Linking mental preparedness with good nutrition, exercise and other prenatal care is a large part of the formula. "So much can be learned about mind-body connections through childbirth," she says. "We tend to create fear where we don't need to have it. This can be a time to confront and overcome our fears, then become stronger because of it."
"Ina May's Guide to Childbirth" ($14.95, Bantam) is filled with positive experiences during childbirth. The book also explains what to expect, medically, and how to prepare. "Women lack information about their bodies," Gaskin says. "It's taboo, for example, for us to be able to watch a normal childbirth on TV," and it's not typical for a doctor to advise a patient to take a walk or have sex to induce labor.
More than 2,200 births have been handled by midwives at The Farm. Less than 2 percent were by C-section, as compared to the U.S. average of almost 25 percent. In the 1970s, the national average was less than 5 percent.
Gaskin says the biggest misconception about childbirth in the United States is that it is "an illness - something that a surgeon needs to save you from." She also observes that many doctors "have had little exposure to the natural process of childbirth."
Slowly, that is changing. The "Gaskin maneuver," for example, is a natural way to free the shoulders of babies stuck during birth. Named after the midwife, the method is now a part of obstetrics training and textbooks. Prior solutions, Gaskin says, involved breaking the baby's bones or performing an episiotomy. She learned the maneuver, which involves turning the mother onto her hands and knees, from a savvy midwife in Guatemala, "a woman who couldn't read and lived without furniture."
An estimated 10 percent of all U.S. births involve a midwife. "In most other countries, about 70 percent of births are attended to by a midwife only," Gaskin says. Childbirth in a hospital averages $10,000, compared to $2,000 to $3,000 for a home birth. "We spend more on maternity care than anybody in the world," she contends.
Describing her profession as being "a lot about prevention," she doesn't want midwives to replace obstetricians - just to outnumber them. "We do more than get the baby out, although how you get the baby out is very important."
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Thursday, June 26, 2003
